FOURmula 1+

DEPARTMENT OF HEALTH
Based on Administrative Order No. 2018-0014
Strategic Framework and Implementing Guideline
for FOURmula One Plus for Health (F1+)
Background
Milestones in the PH Health Sector Reform

 1991 – Local Government Code Act

 1995 – National Health Insurance Act
 1999 – Health Sector Reform Agenda
 2005 – FOURmula One for Health
 2011 – Universal Health Care / Kalusugan Pangkalahatan
 2016 – Philippine Health Agenda
Situational Overview
Increasing Expenditures for Health

 Sin Tax Incremental Revenue for

Health exponentially increased
the fiscal space for health
 Increasing PhilHealth Coverage
51% in 2010 to 91% in 2016
 Rising Total Health Expenditures
381B in 2010 to 655B in 2016
Situational Overview
Despite Improvement in health expenditures,
improvement in health outcomes has been marginal
 Infant mortality rate
25 per 1,000 live births in 2008 to
21 per 1,000 live births in 2017
 % of Children Under-five who are Stunted
32.3 in 2008 to 33.4 in 2015
 % of children aged 12-23 mos. given all basic
vaccinations
79.5 2008 to 69.9 in 2017
 National Health Insurance Program
Support value at ~50%
Situational Overview
Philippines remains deeply underserved
Health Outcomes
● High infant-child-maternal mortality rates, especially Ranking Average Life Maternal Under 5 TB Incidence
among the poor (NDHS, FHS) Expectancy Mortality Mortality Rate
Ratio Rate
● 1 out of 3 children stunted (NNS 2015)
● Immunization of children lowest in 25 years at 60% 1st (BEST) Singapore Singapore Singapore Brunei

(NDHS 2013) 2nd Brunei Thailand Malaysia Singapore

3rd Vietnam Brunei Brunei Malaysia
Financial Risk
4th Malaysia Malaysia Thailand Vietnam
● OOP at 56% of Total Health Expenditures (2014)
5th Thailand Vietnam Vietnam Thailand
● Compliance to No Balance Billing for indigent and
6th Indonesia Philippines Indonesia Laos
sponsored members at 63% (2016)
● 1.5 million Filipinos pushed to poverty from access to 7th Philippines Indonesia Philippines Cambodia

health services (WB 2014) 8th Cambodia Cambodia Cambodia Myanmar

9th Myanmar Myanmar Myanmar Indonesia

Health System Responsiveness 10th Laos Laos Laos Philippines

(WORST)
● Inequitable distribution of health workers
● Government health facilities remain overcrowded
Situational Overview Summary
 Significant increase in Fiscal Space for Health only
marginally improved outcomes

 Inequity persists in both access to essential health

services and health outcomes across regions and
provinces, as well as socio-economic quintiles

 There is fragmentation of the health system after

devolution, with blurred accountability
► Aims to attain the goals outlined in the
1) PDP 2017-2022,
2) SDG 2030
3) AmBisyon Natin 2040

► Builds on the concept of FOURmula

One for Health 2005-2010

► A MEDIUM TERM STRATEGIC

FRAMEWORK 2017-2022 which
expands the four pillars and emphasizes
performance accountability towards the
Filipino People
Medium Term
Strategic
Framework

FINANCING
 ► Efficiently mobilize and distribute more resources for
health
• Innovative health taxes, efficient collection and progressive premium
payments; income retention and fiscal autonomy; private health insurance
and HMOs
FINANCING
►Rationalize health spending
• Population-based and personal insurable health services; pooling of funds;
To secure sustainable fixed co-payments and No-balance billing; multi-year budget
investments to improve
health outcomes and ensure ►Focus financial resources towards high impact
efficient and equitable use of interventions
health resources
• Focus on basic and essential; programs for the poor, marginalized and
vulnerable; contributory PDP, SDGs and Ambisyon 2040
 ►Access to quality essential health products &
services
• Essential health service package for all life stages and
specialized services; public health strategies (disease-free zones,
prevention and control; surveillance and monitoring; health
promotion, health emergency)
SERVICE DELIVERY
►Ensure equitable access to health facilities
To ensure the • SDN-responsive HFEP, compliance to standards of care, step-
accessibility of essential down and chronic care
quality health services at ►Ensure equitable distribution of HRH
appropriate levels of
• Aligned with health facilities expansion; engage other NGAs to
care ensure adequate production and quality HRH; Equitable
distribution (high compensation in GIDA)

►Engage service delivery networks (SDNs)

• Providers organized into SDN; families assigned to SDN;
gatekeeping mechanisms; two-referral systems
 ► Harmonize and streamline regulatory systems and
processes
• One-stop shop, automation; 3rd party accreditation; conflict of
interest reviewed and managed; compliant with international
standards; public information
► Innovative regulatory mechanisms for equitable
REGULATION distribution of quality and affordable health goods
To ensure high quality and
and services
affordable health products, • Regulation-specific capacity building; national fee schedule;
network licensing, risk and outcome-based regulation; HRH
devices, facilities and services
production and distribution)
 ► Strengthen sectoral leadership & management
• Stronger position on social determinants of health; participatory
governance; readiness in possible shifts in government; TA to LGUs
based in LIPH
► Improve organizational development & management
GOVERNANCE • Responsive organizational structure, staffing pattern and skill mix;
competency-based learning and succession planning

To strengthen leadership & ► Improve processes for procurement & supply chain
management capacities, management
coordination, and support • Improve system for planning, forecasting, coordination and
mechanisms necessary to determination of health goods; strengthen procurement and logistics
ensure functional, people-
management system
centered and participatory
health systems ► Ensure generation and use of evidence in health policy
dev’t and decision making
• Culture of research and evidence use; improve access to data; HTA
institutionalization
 ►Improve transparency and
accountability
• Integrate tools and systems; performance accountability;
scorecards
Performance
►Shift to outcome-based
Accountability
management approach
To use management systems to • Regular monitoring and reviews; performance link to
drive better execution of policies incentives
and programs in the DOH while
ensuring responsibility to all
stakeholders
Implementing Guideline
 All DOH units to align policies, programs and activities to the F1+ for Health

 All national gov’t agencies/ entities with funds and activities related to health is
strongly encouraged to align its policies, programs and funds for health to the F1+
for Health

 Use the Performance Governance System, along with other performance

management systems such as Quality Management Systems, Integrity
Management Program, and Strategic Performance Management System for F1+ for
Health implementation

 The National Objectives for Health to supplement the F1+ for Health, and
Performance Scorecards stratified to different levels shall be developed to ensure
accountability of all stakeholders
Thank You
EMAIL: dohplanning@gmail.com